摘要目的 从冠状动脉(冠脉)斑块的影像学、血浆炎症介质水平等方面综合评价冠脉斑块易损性.方法 将冠脉造影显示为单支病变的58例患者,按造影结果分为Ⅰ型病变组(16例)、Ⅱ型病变组(25例)、Ⅲ型病变组(17例)及对照组(17例).其中行血管内超声(IVUS)检查的28例患者分为急性冠脉综合征(ACS)组和稳定性心绞痛组2个亚组.采用酶联免疫吸附法测定血浆高敏C反应蛋白(hs-CRP)、金属基质蛋白酶(MMP,包括MMP-2、MMP-9)、CD40配体(CD40L)和妊娠相关蛋白-A(PAPP-A)水平.结果 Ⅱ型病变组血浆MMP-2、MMP-9和PAPP-A水平显著高于Ⅰ型病变组(P＜0.05)、Ⅲ型病变组(P＜0.05)和对照组(P＜0.001);线性相关分析显示,Ⅱ型病变组hs-CRP与MMP-2显著正相关(r=0.508);MMP-2与MMP-9、CD40L、PAPP-A显著正相关(r=0.647、0.704、0.751);MMP-9与CD40L、PAPP-A显著正相关(r=0.491、0.639);CD40L与PAPP-A(r=0.896)显著正相关.IVUS亚组分析表明,ACS组的"罪犯"病变斑块面积、斑块负荷、高危斑块发生率、重构指数和正重构均显著大于对照组(P=0.000、0.037、0.028、0.015和0.040);ACS组血浆hs-CRP、MMP-2、MMP-9和PAPP-A水平也显著升高(P=0.033、0.000、0.000和0.027).结论 冠脉造影、IVUS检查结合检测血浆炎症介质水平更有助于判断冠脉斑块的易损性.

abstractsobjective To evaluate the vulnerability of coronary artery plaque with coronary angiography(CAG),intravascular ultrasound(IVUS)and the levels of plasma inflammatory markers.Methods 58 consecutive patients with lesion of a single blood vessel demonstrated successfully by CAG were randomly divided into 3 groups based on the angiographic morphology of the the lesions:type Ⅰ lesion group(n=16),type Ⅱ lesion group(n=25),type Ⅲ lesion group(n=17).Meantime,a control group of stable angina(n=17)was established.A subgroup of 28 patients(including 18 acute coonary sysdrome (ACS)patients and 10 stable angina control patients)who underwent IVUS study were analyzed.Then the plasma levels of high sensitivity CRP(hs-CRP),matrix metalloproteinase(MMP,including MMP-2 and MMP-9),CD40 ligand(CD40 L)and pregnancy associated plasma protein-A(PAPP-A)were measured with ELISA.Analyses were performed by statistical package SPSS 11.0.Results The plasma levels of MMP-2,MMP-9 and PAPP-A in typeⅡ lesion group were significantly higher than the other groups(P＜0.05,0.05,0.001,respectively).In type Ⅱ lesion group,linear correlation analysis manifested significantly positive correlation between levels of hs-CRP and MMP-2(r=0.508);MMP-2 and MMP-9,CD40 L,PAPP-A(r=0.647,0.704,0.751,respectively);MMP-9 and CD40L,PAPP-A(r=0.491,0.639,respectively);CD40L and PAPP-A(r=0.896).IVUS subgroup analysis showed that the area of plaques and plaques burden in culprit lesion,the incidence of high-risk plaques,remodeling index(RI)and positive remodeling percentage in ACS patients were significantly greater than those in the control group(P=0.000,0.037,0.028,0.015,0.040,respectively).Compared with the control group,the plasma levels of hs-CRP,MMP-2,MMP-9 and PAPP-A were markedly elevated(P=0.033,0.000,0.000,0.027,respectively).Conclusions CAG and IVUS combined with the study on plasma levels of inflammation mediators were helpful in judging the vulnerability of coronary artery plaques.